Provider Demographics
NPI:1073769998
Name:LYBARGER, HOLLY LEE
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LEE
Last Name:LYBARGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:LEE
Other - Last Name:LYBARGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:529 S PATTEN RD
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-3007
Mailing Address - Country:US
Mailing Address - Phone:207-538-3700
Mailing Address - Fax:207-528-2880
Practice Address - Street 1:50 SUMMER ST
Practice Address - Street 2:
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-1400
Practice Address - Country:US
Practice Address - Phone:207-538-3700
Practice Address - Fax:207-528-2880
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81948363LF0000X
MEAP081948363LF0000X
IN28207934A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000827693OtherANTHEM - RPA
IN201167370Medicaid
COAPN-0992639-NPOtherMEDICAL LICENSE
COAPN-0992639-NPOtherMEDICAL LICENSE
IN259370012Medicare PIN